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Office of Human Resources

Family Medical Leave (FMLA)

Family Medical Leave (FMLA) is an unpaid leave granted to eligible employees for up to 12 weeks during a 12-month period for a qualifying reason, including:

  • The birth or care of a newborn child
  • Placement of a child for adoption or foster care and care for the newly placed child
  • To care for a spouse, domestic partner, child, or parent with a serious health condition
  • The employee’s own serious health condition
  • To care for a service/military family member recovering from a serious injury sustained in the line of duty
  • A service/military family member is, or will be, deployed to a foreign country

You can reference the FMLA policy on the University’s policies website for full details.

View full policy

Requesting Family Medical Leave

Request FMLA by completing the applicable medical certification form below and returning to University of Rochester’s Leave Administration department within 15 days. Leave Administration is asking anyone submitting FMLA forms and documents to email HR_FMLA@ur.rochester.edu or fax to (585) 276-1361.

Download the medical certification form from the official U.S. Department of Labor website below.

Medical certification forms

If you have trouble viewing the PDFs below, your PDF viewer may not be able to display these types of documents. You can download the files and open them with the latest version of Adobe Reader.

If unable to print a form, complete this request form

When processed, Leave Administration sends an approval/denial letter to the employee, supervisor, and Business Partner. When FMLA time is needed, follow department/unit call off procedures, be sure to indicate that the absence is FMLA. Use of FMLA time is confidential and notice that call off is FMLA should be to supervisor/designee only.

Helpful resources

In addition to the information you’ll find in the official policy, these documents and guides might be helpful to you.

 

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